A memo sent to all Veterans Affairs Department health directors in 2010 warning them against using “gaming strategies” to improve scores on patient appointment reports has resurfaced as part of the ongoing probe of scheduling failures at some VA medical centers.

William Schoenhard, deputy under secretary for health for operations and management, sent a detailed memo in April 2010 to the regional directors calling for “immediate action” to review scheduling practices to eliminate “inappropriate” strategies.

Sen. Johnny Isakson, R-Ga., asked VA Secretary Eric Shinseki last Thursday in a contentious Senate Veterans’ Affairs Committee whether he was aware of the eight-page instruction, which details what practices schedulers should avoid.

Shinseki said he had not seen the memo, which Military Times previously reported on.

VA Under Secretary for Health Dr. Robert Petzel, who resigned Friday just weeks before his scheduled retirement, told Isakson he knew of the memo and said the VA has worked “hard to root out inappropriate uses of the scheduling system and abuses.”

“It’s absolutely inexcusable,” Petzel said.

According to Shinseki, 6,000 employees were “involuntarily removed for poor performance or misconduct” in 2012 and 2013, including some senior executives. The dismissals, in the form of firings, retirements or transfers, were not all related to the scheduling problems.

White House Press Secretary Jay Carney said Monday that President Obama supports Shinseki and agreed to transfer White House Deputy Chief of Staff Rob Nabors last week to VA to oversee an audit of scheduling practices in VA medical facilities.

On Sunday, White House Chief of Staff Denis McDonough described Obama as being “madder than hell” about reports of off-the-books appointment lists and patient deaths related to delays in care.

But Sen. Patty Murray, D-Wash., one of the lawmakers who quizzed Schoenhard in 2012 about questionable scheduling practices at VA medical centers, said Thursday she is disappointed in the repeated failures and believes “decisive action” is needed now.

“The standard practice at VA seems to be to hide the truth in order to look good. That has got to change once and for all,” Murray said.

While the VA health system has faced longstanding problems with its scheduling system and appointment wait times, the problems reached crisis level last month following media reports alleging that a secret wait list maintained at the VA Phoenix Health System may have contributed to the deaths of at least 40 patients.

The results of the VA-wide audit, led by Nabors, are expected within three weeks.

The VA Inspector General anticipates wrapping up its investigation into the Phoenix allegations in August.

Meanwhile, the summer could bring more heat to the department for its scheduling and referral practices: A GAO report on VA’s management of specialty care consults is expected to be released.

GAO analyst Debra Draper said preliminary results have uncovered several problems, including delays in care, veterans not receiving needed care and system-wide closure of 1.5 million consults older than 90 days with no explanation as to why they were closed.